March 25, 2009 / 8:22 PM / 10 years ago

AMA sues WellPoint over reimbursements

LOS ANGELES (Reuters) - A group of doctors and medical societies led by the American Medical Association sued WellPoint Inc on Wednesday, accusing it of fixing patient reimbursement rates for out-of-network medical services artificially low.

The lawsuit, filed in Los Angeles federal court, follows similar claims led by the AMA against Cigna Corp and Aetna Inc in federal court in New Jersey, and against UnitedHealth Group Inc in New York federal court.

WellPoint said on Wednesday in response to the lawsuit that it was “committed to providing appropriate reimbursement for out of network services.”

“We are in the process of reviewing the complaint and are unable to comment further at this time,” WellPoint spokeswoman Krisin Binns said in a statement.

The AMA’s lawsuit accuses WellPoint of overcharging patients for out-of-network services by relying on faulty data provided by a database run by UnitedHealth.

In January, UnitedHealth agreed to pay $350 million to resolve class action litigation and $50 million to settle an investigation by New York Attorney General Andrew Cuomo into the database.

Cuomo accused UnitedHealth of skewing patient reimbursement rates so that as many as 100 million people paid more than they should have for out-of-network medical services.

In the settlement with the attorney general, UnitedHealth shuttered the Ingenix medical billing information service, which was used by most major health insurers to set rates, and paid $10 million to help finance a new independent database to determine market rates for health-care procedures.

WellPoint has already contributed $10 million and Aetna $20 million toward the cost of the new system.

A U.S. Senate Committee has scheduled hearings on Thursday in Washington to examine allegations of insurer price fixing. AMA President Nancy Nielsen is scheduled to testify, an AMA spokesman said.

Reporting by Gina Keating; Editing by Gary Hill

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